High School Students Increasingly Specializing in One Sport

MedicalResearch.com Interview with:

Michael G. Ciccotti, MD Professor of Orthopaedic Surgery Rothman Institute Chief of Sports Medicine, and Director of the Sports Medicine Fellowship Thomas Jefferson University

Dr. Michael Ciccotti

Michael G. Ciccotti, MD
Professor of Orthopaedic Surgery
Rothman Institute
Chief of Sports Medicine, and
Director of the Sports Medicine Fellowship
Thomas Jefferson University

MedicalResearch.com: What is the background for this study? 

Response: No doubt sports plays a huge role in the United States and all over world with millions of young people between the ages 6 and 18 participating in an organized sport on a regular basis.

Over the past decade, there has been a tremendous focus on youth single sport specialization (SSS), with pressure from coaches, parents and the athletes themselves to participate in one sport year round. Many participants, coaches and parents believe that early specialization may allow the young athlete to become better and progress more quickly in their sport, perhaps allowing them a greater chance of becoming a professional athlete. This drive toward early specialization has been fueled by popular icons i.e. Tiger Woods (golf) and Lionel “Leo” Messi (soccer) as well as by media hits such as Friday Night Tykes (young football players) and The Short Game (7-year old golfers). The pop-psych writer, Malcolm Gladwell, whose The 10,000 Hour Rule (in his book Outliers) holds that 10,000 hours of “deliberate practice” are needed to become world-class in any field may have also encouraged the specialization trend.

There is little doubt that youth sports may encourage a lifelong interest in a healthy lifestyle as well as improved self-esteem and social relationships. The flip side is that extreme training and singular focus on a sport can lead to stress on the developing musculo-skeletal system, a pressure to succeed at all costs, reduced fun, burnout and sometimes social isolation.

The dilemma we are beginning to scratch the surface of is does single sport specialization enhance the likelihood of getting to an elite level and does it increase the risk of injury? There is a growing sense in the medical community that SSS raises injury risk without enhancing progression to a higher level.

MedicalResearch.com: What are the main findings?

Response: In our study we surveyed over 3000 athletes, from high school, college age and professional groups. The surveys were administered by the athletic staff and asked questions about injuries, age of specialization and why. We defined specialization to one sport with intensive participation for 8 months or more out of the year and excluding all other sport activities.

The results were fascinating. The professional athletes reported that they began to compete at an earlier age but played all different sports. The current youngest athletes in high school specialized in one sport at an earlier age, two years earlier than college or professional athletes reported, and had more injuries than the professional athletes. The youngest athletes were more likely to feel that early SSS was necessary, while professional athletes didn’t think it was necessary to specialize early to achieve an elite level of success.

There is some empirical evidence that early specialization does not necessarily lead to enhanced success i.e. Swedish tennis players (1), and may increase the risk of injury i.e. ACL injuries in young female soccer players (2).

MedicalResearch.com: What are the limitations of this study?

Response:There are several limitations to this line of study, including the multifactorial influences on the young athlete with competing social, physical and psychological factors.

Our study limitations include:
1: The survey was retrospective, and based on the ability of the athlete to recall injuries and timelines.
2: Professional athletes may have physical and mental attributes that would allow them to attain an elite level without the need for specialization.
3: We looked at different groups at one defined period of time; it is possible that the athletic landscape is more competitive now than when current professional athletes were in high school.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We hope our work generates more interest in examining the effects of early sports specialization.
1. We want to better understand the biomechanical differences between youth athletes and adults. For example, we know that a young person throws a ball differently than an adult. Ideally, we would like to determine the optimal biomechanics at each age to be able to intercede to help individuals throw better.
2. We need to better understand the basic science of injury and healing. Youths and adults have different injury profiles i.e. adults may have more tendon injuries and young people may sustain injuries to their growth plates. Similarly, healing occurs at a different pace in youth and adulthood.
3. As researchers, we have to develop a standardized sports specialization survey tool, so that we agree on how to best ask the appropriate questions and to be able to adequately pool date. We are working on such a tool now.
4. We need prospective studies that follow athletes for 10-15 years and see what happens to them in terms of injury and performance.
5. We would like to know if there are complementary measures or sports that can help an athlete achieve her/his full potential. For example, if you play a predominately lower body sport such as soccer, does developing opposing muscles improve your performance and reduce the risk of injury?
6. We need to consider the psychosocial aspects of sports, to learn what works best to avoid the risk of burnout, social isolation or undue competitive pressure. This is especially true in light of the great variability of young athletes in terms of their physical and social development at a given age.
We should also note that major league sports organizations are very much interested in this research and we are fortunate to have relationships with the major league teams in the Philadelphia area.

References:
1)Sports Specialization in Young Athletes Evidence-Based Recommendations
Sports Health. 2013 May; 5(3): 251–257.
Neeru Jayanthi, MD, Courtney Pinkham, BS, Lara Dugas, PhD, Brittany Patrick, MPH, and Cynthia LaBella, MD
doi: 10.1177/1941738112464626

2) Are Female Soccer Players at an Increased Risk of Second Anterior Cruciate Ligament Injury Compared With Their Athletic Peers?
Allen MM, Pareek A, Krych AJ, Hewett TE, Levy BA, Stuart MJ, Dahm DL.
Am J Sports Med. 2016 Oct;44(10):2492-2498.
https://www.ncbi.nlm.nih.gov/pubmed/27261476

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Citation:
Single Sport Specialization in Youth Sports: A Survey of High School, Collegiate, and Professional Athletes Meghan E. Bishop, MD, Philadelphia, PA Patrick S. Buckley, MD, Philadelphia, PA Michael G. Ciccotti, MD, Philadelphia, PA Steven B. Cohen, MD, Media, PA William D. Emper, MD, Bryn Mawr, PA Dominique Exume, BA, Philadelphia, PA Sommer Hammoud, MD, Philadelphia, PA Patrick Kane, MD, Vail, CO Stephen Selverian, BA, Chadds Ford, PA A survey of high school, collegiate, and professional athletes examining the topic of early youth single sport specialization

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